Provider Demographics
NPI:1154687515
Name:MONUMENTAL VIEWS OPTICAL, LLC
Entity Type:Organization
Organization Name:MONUMENTAL VIEWS OPTICAL, LLC
Other - Org Name:FOR EYES OPTICAL, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-242-3323
Mailing Address - Street 1:1190 BOOKCLIFF AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8133
Mailing Address - Country:US
Mailing Address - Phone:970-242-8727
Mailing Address - Fax:970-242-8774
Practice Address - Street 1:1190 BOOKCLIFF AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8133
Practice Address - Country:US
Practice Address - Phone:970-242-8727
Practice Address - Fax:970-242-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28155332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6686680001Medicare NSC
COE94490Medicare UPIN
COC808774Medicare PIN